Change in prostate specific antigen following androgen stimulation is an independent predictor of prostate cancer diagnosis.

PURPOSE: We tested the hypothesis that a single exogenous androgen injection in men with low prostate specific antigen would provoke a differential prostate specific antigen response that would correlate with the presence and volume of cancer at biopsy. MATERIALS AND METHODS: Following institutional review board approval 40 men with prostate specific antigen between 2.5 and 4.0 ng/ml were given 1 intramuscular injection of 400 mg testosterone cypionate at the start of the study. Prostate specific antigen and early morning serum testosterone were measured at baseline, 48 hours, and weeks 1, 2 and 4. All men underwent 12-core transrectal ultrasound guided biopsy at week 4. RESULTS: Of the 40 men 18 (45%) were diagnosed with prostate cancer. The mean change in prostate specific antigen from baseline to 4 weeks was 3.1 to 3.4 ng/ml (9.7%) in men found to have benign findings on biopsy compared to a mean increase of 2.9 to 3.8 ng/ml (29%) in those with prostate cancer (p = 0.006). The change in prostate specific antigen following androgen stimulation was significantly associated with the percent of tissue involved with cancer and it was an independent predictor of cancer diagnosis on univariate and multivariate analysis. CONCLUSIONS: An increase in prostate specific antigen following androgen stimulation in men with prostate specific antigen between 2.5 and 4.0 ng/ml was highly predictive of the subsequent diagnosis of prostate cancer and it correlated with disease volume. If these findings are corroborated, prostate specific antigen provocation may become an important strategy to identify men at risk for harboring prostate cancer and minimize the number undergoing unnecessary biopsies.

Quantifying the impact of prostate volumes, number of biopsy cores and 5alpha-reductase inhibitor therapy on the probability of prostate cancer detection using mathematical modeling.

PURPOSE: Previous studies demonstrated a negative correlation between prostate volume and biopsy yield. By decreasing prostate volume 5alpha-reductase inhibitors may enhance cancer detection, which may explain the greater detection of high grade tumors in the finasteride arm of the Prostate Cancer Prevention Trial. MATERIALS AND METHODS: A mathematical model was constructed to analyze the effects of prostate and tumor volumes, and biopsy core number on cancer detection. The effects of the volume reduction observed with finasteride in the Prostate Cancer Prevention Trial were also modeled, as was the potential reduction in tumor volume needed to explain the observed difference in prostate cancer detection. The model was also applied to the Reduction by Dutasteride of Prostate Cancer Events study. RESULTS: A higher number of biopsies are required to ensure a detection probability of 0.90 or greater in larger glands or with smaller tumors. In the Prostate Cancer Prevention Trial for a tumor volume of 1 cc a 17% increase in the detection rate in the finasteride arm would be predicted if there was no change in tumor volume, likewise the rate would be 11% to 17% for the dutasteride arm of the Reduction by Dutasteride of Prostate Cancer Events study. The calculated reduction in tumor volume needed to explain the difference in cancer detection between the finasteride and placebo arms of the Prostate Cancer Prevention Trial would be 51% to 66%. CONCLUSIONS: This model provides guidance on the optimal number of biopsy cores that accord with an earlier model. These findings also suggest that, if there were no reduction in tumor volume, 5alpha-reductase inhibitor therapy could lead to excess cancer detection, including high grade tumors.

The use of histone deacetylase inhibitor FK228 and DNA hypomethylation agent 5-azacytidine in human bladder cancer therapy.

The long-term disease-free survival in patients with metastatic transitional cell carcinoma (TCC) is still considerably low. Novel chemotherapeutic agents are needed to decrease the morbidity and mortality of TCC. In this study, we have evaluated several epigenetic modifiers for their therapeutic application in bladder cancer. Both histone deacetylase inhibitors (FK228, TSA) and DNA hypomethylating agent (5-Azacytidine) were tested using in vitro assays such as cell viability, cell cycle analysis and western blot to determine their mechanisms of action. Drug combination experiments were also designed to study any additive or synergistic effects of these agents. In addition, two bladder cancer xenograft models (one subcutaneous and one orthotopic) were employed to assess the therapeutic efficacy of these agents in vivo. Three agents exhibited various growth inhibitory effects on 5 different TCC cell lines in a dose- and time-dependent manner. In addition to G2/M cell cycle arrest, FK228 is more potent in inducting apoptosis than the two other single agents, and combination of both FK228 and 5-Aza further enhances this effect. p21 induction is closely associated with FK228 or TSA but not 5-Aza, which is mediated via p53-independent pathway. Consistent with in vitro results, FK228 exhibited a significant in vivo growth inhibition of TCC tumor in both subcutaneous and orthotopic xenograft models. FK228 is a potent chemotherapeutic agent for TCC in vivo with minimal undesirable side effects. The elevated p21 level mediated via p53 independent pathway is a hallmark of FK228 mechanism of action.

Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus.

OBJECTIVE: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. METHODS: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. RESULTS: There were 29 men and 17 women with a mean age of 60.2 +/- 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%. CONCLUSIONS: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.

Critical analysis of prostate-specific antigen doubling time calculation methodology.

BACKGROUND: Prostate-specific antigen (PSA) doubling time (PSADT) has emerged as an important surrogate marker of disease progression and survival in men with prostate carcinoma. The literature is replete with different methods for calculating PSADT. The objective of the current study was to identify the method that best described PSA growth over time and predicted disease-specific survival in men with androgen-independent prostate carcinoma. METHODS: PSADT was calculated for 122 patients with androgen-independent prostate carcinoma using 2 commonly used methods: best-line fit (BLF) and first and last observations (FLO). Then, PSADT was calculated by using both a random coefficient linear (RCL) model and a random coefficient quadratic (RCQ) model. Statistical analysis was used to compare the ability of the methods to fit the patients' PSA profiles and to predict disease-specific survival. RESULTS: The RCQ model provided the best fit of the patients' PSA profiles, as determined according to the significance of the added parameters for the RCQ equation (P < or = 0.002). The PSADT estimates from the FLO method, the RCL model, and the RCQ model were highly significant predictors (P < 0.001) of disease-specific survival, whereas estimates from the BLF method were not found to be significant predictors (P = 0.66). PSADT estimates from the RCQ and RCL models provided an improved correlation of disease-specific survival (both R(2) = 0.55) compared to the FLO (R(2) = 0.11) and BFL (R(2) = 0.003) methods. CONCLUSIONS: Random coefficient methods provided a more reliable fit of PSA profiles than other models and were superior to other available models for predicting disease-specific survival in patients with androgen-independent prostate carcinoma. The authors concluded that consideration should be given to applying the RCL or RCQ models in future assessments of PSADT as a predictive parameter.

Pre-treatment nomogram for disease-specific survival of patients with chemotherapy-naive androgen independent prostate cancer.

OBJECTIVE: Our objective was to develop a nomogram that predicts the probability of cancer-specific survival in men with untreated androgen-independent prostate cancer (AIPC). METHODS: AIPC was diagnosed in 129 consecutive patients between 1989 and 2002. No patient received cytotoxic chemotherapy. Univariate and multivariate Cox regression models were used to test the association between prostate-specific antigen (PSA) level at initiation of androgen deprivation, PSA doubling time (PSADT), PSA nadir on androgen deprivation therapy (ADT), time from ADT to AIPC, and AIPC-specific mortality. Multivariate regression coefficients were then used to develop a nomogram predicting AIPC-specific survival at 12-60 mo after AIPC diagnosis. Two-hundred bootstrap resamples were used to internally validate the nomogram. RESULTS: AIPC-specific mortality was recorded in 74 of 129 patients (57.4%). Other-cause mortality was recorded in 7 men (5.4%). Median overall survival was 52.0 mo (mean, 36.0 mo) and median AIPC-specific survival was 54.0 mo (mean, 35.0 mo). In univariate regression models, all variables were significant predictors of AIPC-specific survival (p < or = 0.02). In multivariate models, PSADT and time from androgen deprivation to AIPC remained statistically significant (p < or = 0.004). Bootstrap-corrected predictive accuracy of the nomogram was 80.9% versus 74.9% for our previous model. CONCLUSIONS: A nomogram predicting AIPC-specific survival is between 13% and 14% more accurate than previous nomograms and 6% more accurate than tree regression-based predictions obtained from the same data. Moreover, a nomogram approach combines several advantages, such as user-friendly interface and precise estimation of individual recurrence probability at several time points after AIPC diagnosis, which all patients deserve to know and all treating physicians need to know.

Prognostic model of event-free survival for patients with androgen-independent prostate carcinoma.

BACKGROUND: The current study was conducted to develop a prognostic model of event-free survival (EFS) in men with androgen-independent prostate carcinoma (AIPC). METHODS: Data from 160 patients diagnosed with AIPC between 1989-2002 were reviewed. No patient had received cytotoxic chemotherapy. A univariate Cox proportional hazards model identified significant predictors of EFS. Recursive partitioning analysis divided these significant variables into prognostic risk groups. The final prognostic model was tested with a Cox proportional hazards model. RESULTS: The final prognostic risk model included the presence of metastatic disease at the time of androgen-independent disease progression (P = 0.040), time to prostate-specific antigen (PSA) recurrence (P = 0.043), and PSA doubling time (P < 0.01). Three highly independent risk groups were identified. The observed median EFSs were 6.1 months (95% confidence interval [95= CI], 3.4-8.8 months), 33.6 months (95= CI, 25.3-41.9 months), and 96.1 months (95= CI, 57.9-134.3 months) for the low-risk, intermediate-risk, and high-risk groups, respectively. Each risk group was found to be independently predictive of EFS (P < 0.01). Patients who died of prostate carcinoma experienced significantly more clinical events than those who died of other causes (P < 0.01). CONCLUSIONS: The prognostic model in the current study stratified patients into three highly significant and independent risk groups for EFS. A detailed PSA history and knowledge of metastatic disease are sufficient to risk-stratify patients with AIPC. One very unique aspect of this model was that it was developed from a patient cohort that never received chemotherapy.

The effect of combined androgen ablation on the expression of alpha1A-adrenergic receptor in the human prostate.

BACKGROUND: This study was designed to determine whether androgen ablation (AA) affects expression of alpha1A-adrenergic receptors (AR) in the human prostate. METHODS: Concentrations of alpha1A-AR mRNA were determined in benign prostatic tissue from patients undergoing surgery after a 3-month course of combined androgen ablation (CAD) therapy with leuprolide and flutamide, and a matched group of untreated patients with clinical BPH. RESULTS: Mean concentration of alpha1A-AR in the AA group was 0.53 +/- 0.53 SD (range 0.026-1.55) attomol/mg. Control mean was 0.29 +/- 0.22 SD (range 0.02-0.69; P = 0.3, two tailed t-test). Tissue composition did not statistically differ between the two groups. Expression of alpha1A-AR correlated with concentration of smooth muscle myosin heavy chain (SMMHC) (r = 0.84, P = 0.001). No significant differences were observed after adjusting for SMMHC content. CONCLUSIONS: A 3-month course of CAD does not appear to have a significant effect on alpha1A-AR mRNA expression in the human prostate.

The natural history of androgen independent prostate cancer.

PURPOSE: We describe the natural history of androgen independent prostate cancer (AIPC) in the modern prostate specific antigen (PSA) era. MATERIALS AND METHODS: Data from 160 patients diagnosed with AIPC between 1989 and 2002 were reviewed. No patient had received cytotoxic chemotherapy. Univariate and multivariate proportional hazards models were constructed to identify significant risk factors for cancer specific survival. Recursive partitioning analysis stratified patients into prognostic risk groupings. The types and frequencies of cancer specific complications per risk grouping were compared. RESULTS: The final prognostic risk model included nadir PSA on androgen deprivation therapy (p = 0.023), time to PSA recurrence (p = 0.006) and prostate specific antigen doubling time (p <0.01). Three highly independent risk groupings were identified. The observed median cancer specific survivals were 14.0 months (95% CI, 8.3-19.8), 38.4 months (95% CI, 26.9-49.9) and 89.1 months (95% CI, 69.0-109.2) for low, intermediate and high risk groupings, respectively (p <0.001). Patients in the low risk grouping experienced significantly fewer cancer specific complications (p = 0.003). CONCLUSIONS: This prognostic model stratified patients into 3 highly significant and independent risk groupings. A detailed PSA history alone is sufficient to risk stratify patients with AIPC.

Prostate-specific antigen doubling time predicts response to deferred antiandrogen therapy in men with androgen-independent prostate cancer.

OBJECTIVES: To identify the pretreatment variables that are predictive of response and the duration of response to deferred antiandrogen therapy in men with androgen-independent prostate cancer (AIPC). METHODS: A total of 375 patients receiving androgen deprivation therapy for advanced prostate cancer between 1977 and 2002 had medical records available for retrospective review. Of these 375 patients, 163 were diagnosed with AIPC. The inclusion criteria included (1) diagnosis of AIPC and (2) treatment with deferred antiandrogen therapy. AIPC was biochemically defined as two consecutive rises in the prostate-specific antigen (PSA) level during androgen deprivation therapy. The treatment response to deferred antiandrogen therapy was defined as a 50% or greater decline in the pretreatment PSA level. The prognostic value of various pretreatment parameters was determined with the appropriate statistical methods and tested with a Cox proportional hazards model. RESULTS: Of the 163 patients with AIPC, 36 were treated with deferred antiandrogen therapy. Of these 36 patients, 12 (33.3%) experienced a PSA response. The median PSA failure-free survival was 9.0 months (95% confidence interval 5.2 to 12.9). The only pretreatment variable predictive of a PSA response was the PSA doubling time (PSADT). The mean PSADT in responders was 12.7 months versus 7.5 months in nonresponders (P = 0.037). Moreover, PSADT was the only statistically significant variable on univariate analysis of PSA failure-free survival in responders (hazard ratio 0.202, 95% confidence interval 0.041 to 0.990, P = 0.049). No statistically significant difference was found in cancer-specific survival between responders and nonresponders (P = 0.1501). CONCLUSIONS: The PSADT predicted both the response and the duration of the response to deferred antiandrogen therapy in patients diagnosed with AIPC.

Molecular imaging in prostate cancer.

Prostate cancer (PCa) is the most common non-cutaneous malignancy in men. New ways to diagnose this cancer in its early stages are needed. Unique genetic and biochemical changes in the cell pave the way for tumors to grow and metastasize. Novel imaging approaches attempt to detect pathological processes in cancer cells at the molecular level. This has led to the establishment and development of the field of molecular imaging. Positron emission tomography (PET), magnetic resonance spectroscopic imaging (MRSI), magnetic resonance imaging (MRI), and radiolabeled antibodies are a few of the modalities that can detect abnormal tumor metabolic processes in the clinical setting. Other imaging techniques are still in their early phase of development but hold promise for the future, including bioluminescence imaging (BLI), measurement of tumor oxygenation, and measurement of uptake of iodine by tumors. These techniques are non-invasive and can spare the patient undue morbidity, while potentially providing early diagnosis, accurate follow-up and, finally, valuable prognostic information.

Nadir prostate-specific antigen as a predictor of progression to androgen-independent prostate cancer.

OBJECTIVES: To determine the value of the before and after treatment level of prostate-specific antigen (PSA) to predict the time to androgen-independent progression (AIP) in patients with advanced prostate cancer who received androgen-deprivation therapy (ADT) at the time of recurrence or progression. METHODS: The records of 153 patients with advanced or metastatic prostate cancer who were treated with ADT were retrospectively reviewed. Fifty-six percent of the patients were initially treated with ADT. In the remainder, ADT was started at progression and/or failure. AIP was defined as two consecutive elevations of serum PSA above the nadir value by any threshold. Kaplan-Meier and multiple logistic regression analyses were used to determine the potential predictors of AIP. RESULTS: The median duration of the PSA response was 24 months. The most important predictors of the time to AIP were the initial Gleason grade and the nadir PSA level after the initiation of ADT. The odds ratio of having a response greater than 24 months was 15-times higher in patients achieving an undetectable serum PSA level versus those who did not. For each point increase in the Gleason sum, patients had a five times higher chance of progressing to AIP in 24 months or less. CONCLUSIONS: The ability to achieve an undetectable nadir PSA level and the initial Gleason grade are significant predictors of the time to AIP in men treated with ADT for metastatic and advanced prostate cancer.

Enfermedad diverticular aguda: experiencia en cinco años en el Hospital Vargas de Caracas / Acute diverticular disease: experience in five years in the Hospital Vargas de Caracas

Se evaluaron 34 pacientes retrospectivamente en un período de 5 años egresados con diagnóstico de diverticulitis o sus complicaciones. La edad promedio 59.47 años con predominancia de sexo femenino 68%, los datos clínicos recopilados correspondieron en la literatura. Los estudios paraclínicos utilizados fueron; Rx. simple de abdomen, ecosonograma, colon por enema, colonoscopia, estos dos últimos fueron más especificos. 13 pacientes recibieron tratamiento médico exclusivo, 12 pacientes se inició tratamiento médico y posteriormente quirúrgico, 9 casos requirieron cirugía al ingreso. En 4 de los 21 operados el hallazgo fue diverticulitis simple, 9 plastrón diverticular, 5 peritonitis fecal y 3 abscesos pericolónicos. A 16 de los 21 operados se practicó resección del segmento comprometido seguido de anastomosis primaria en 4 casos, 1 anastomosis primaria más colostomía protectora, 8 operaciones de Hartman y colostomía más fístula mucosa 3. En 5 pacientes se realizó colostomía más drenaje. La mortalidad general fue de 29.41%, 1 paciente murió sin ser operado séptico con una peritonitis fecal, 2 pacientes mueren por causa no relacionada con el procedimiento quirúrgico, los 7 restantes mueren sépticos. Se concluye que al presentarse complicaciones de la diverticulitis la mortalidad aumenta, la remoción del segmento afectado es importante en el tratamiento y la selección del procedimiento posterior a resección debe favorecer a la operación de Hartman donde el pronóstico es mejor

Trauma punzo-penetrante del abdomen anterior: indicaciones para la laparotomía / Prenetrating anterior abdominal wounds: indications for the laparotomy

El manejo de las heridas punzo-penetrantes del abdomen anterior continua siendo controversial en los últimos 5 años. Nuestra política ha sido la de explotar quirúrgicamente a aquellos pacientes que ingresan con signos abdominales agudos, shock, evisceración y heridas por punzón y en ausencia de algunas de estas indicaciones a todos los pacientes que se les diagnostique lesión de la aponeurosis subyacente a la herida. En un estudio retrospectivo de este abordaje obtuvimos de un total de 57 pacientes un 35% de laparotomías fallidas. La exploración local de la herida demostró excelente sensibilidad y especifidad 100% y 94% respectivamente, pero una especificidad del 80% para el diagnóstico de lesiones viscerales, la evisceración se acompañó de un 77% de lesiones intraabdominales. Todos los pacientes que ingresaron con signos clínicos de peritonitis y shock tenían lesiones. El promedio de hospitalizados, de 5.6 días y de 2 días en los casos de hospitalización, de 5.6 días y de 2 días en los casos de laparotomías fallidas, la morbilidad general fue de 10.53% y de 5.88% de los casos que no tenían lesiones. Hubo un solo deceso que no correspondió al grupo de laparotomías fallidas

Traumatismos cardíaco quirúrgico: experiencia en el Hospital Vargas / Surgical cardiac traumatism: experience in the Hospital Vargas

El traumatismo penetrante cardiaco representa una entidad de considerable valor en vista de lo vital de este órgano. Por este motivo se revisaron las historias clínicas de 18 pacientes con ese diagnóstico. Se apreció que el sexo masculino menor de 30 años era el más afectado; siendo la lesión por arma blanca la más frecuentemente implicada como mecanismo de la lesión en el 82% de los casos, localizándose la lesión en el área precordial. La sintomatología es muy variada siendo la taquicardia y la hipotensión los signos más vistos, el trauma cardíaco se asoció a otras lesiones tales como pulmón y lesiones abdominales. Se practico toracotomía amplia en pabellón a 17 casos las indicaciones más frecuentes signos de shock hipovolémico y taponamiento cardíaco, se efectuó en 1 caso toracotomía en la Sala de Emergencia, a un paciente que ingresó sin signos vitales, sobreviviendo posteriormente. La lesión ventrículo derecho fue la más frecuente seguida por el ventriculo izquierdo. La mortalidad fue elevada (56%), con una mortalidad del 11% siendo esta menor que otras series

Hematoma retroperitoneal: análisis de 87 casos en trauma abdominal cerrado y penetrante / Retroperitoneal hematoma: analysis of the 87 cases in blut and penetrating trauma

Se revisaron 87 casos de Hematomas Retroperitoneales (HR) quirúrgicos durante los años 84-88. Fueron clasificados de acuerdo a su localización anatómica y al tipo de trauma. La edad promedio fue 27 años, el 38.18% correspondió a trauma cerrado (TC), 22.98% a heridas por arma blanca (HAB) y el 44.82% a heridas por arma de fuego (HAP). El shock estuvo presente al ingreso en el 54.02%. El diagnóstico preoperatorio se realizó en 2 casos, siendo el lavado peritoneal positivo y la penetración abdominal las principales indicaciones quirúrgicas. Los órganos abdominales lesionados variaron según el tipo de trauma, las visceras huecas (colon y asas delgadas) en HAB y HAF y el bazo e hígado en el TC. En cuanto a su localización los inframesocolicos (IM) y los de los flancos (F) fueron los más frecuentes. En los HR, SM e IM el riñón fue el más lesionado, en los centrales (C) la cava, la aorta y el páncreas, el riñón en los (F) y los vasos olíacos y las fracturas de pelvis en los pélvicos (P). La mayoría de los HR en las HAB y HAF fueron explorados, en el TC se exploraron mayormente los SM y los de los F. Las complicaciones más comunes fueron las sépticas y las hemorrágicas y varió de acuerdo al tipo de trauma, siendo mayor en el TC consideramos que la exploración o no de los HR debe basarse de acuerdo a la zona anatómica involucrada y al tipo de trauma que lo ocasiona. De acuerdo a eso los HR originados por HAB y HAF deben ser explorados, en el caso de TC los HR de localizasión C deben ser explorados debido a los órganos involucrados, los HR de los F se regirán por conducta urológica, determinada por los estudios urológicos..

Pseudo-quistes pancreaticos: experiencia en su manejo en los últimos 15 años en el Hospital Vargas de Caracas / Pancreatic pseudocysts: experience of its management in 15 years old in Hospital Vargas Caracas

El manejo de los pseudoquistes pancreáticos es complejo. El agdvenimiento del ultrasonido y la tomografía axial computarizada ha permitido diagnosticarlos más precoz y frecuente y a la vez han facilitado la comprensión de la historia natural de la enfermedad. Las recomendaciones tradicionales para el manejo y el momento óptimo para la cirugía han variado. Nosotros estudiamos 24 pacientes con diagnóstico de pseudoquiste pancreático observando un 28,5% de remisiones espontáneas. El 71.4% restante ameritó cirugía. Al 26.6% se le practico con una mortalidad del 75%. Al 66.6% se le practicó alguna modalidad de derivación interna con una mortalidad y morbilidad del 20% (cada una). El 6.66% restante se le practicó cirugía excisional sin morbilidad ni mortalidad. La tasa de complicaciones preoperatorias fue del 23.6% y siempre se relacionó con un porcentaje alto de complicaciones postoperatorias. Los pseudoquistes que se originaron después de pancreatitis aguda de origen alcohólico o depués de un traumatismo pancreático se asociaron a una mayor frecuencia de complicaciones preoperatorias y a una mayor mortalidad, además ninguno de ellos sufrió remisión espontánea

Absceso hepático por Salmonella dublin: reporte de un caso / Hepatic abscess due to Salmonella dublin: report of a case

Se presenta el caso de un paciente con absceso hepático único del lóbulo izquierdo por Salmonella dublin al cual se le practicó drenaje quirúrgico. El diagnóstico etiológico microbiano se realizó por cultivo del contenido del absceso y hemocultivo. El paciente recibió tratamiento antimicrobiano con Cefoperazona, Metronidazol y Gentamicina, egresando a los 29 días del post operatorio